Steroid sick day rules Claypath and University Medical Group
Sometimes, the underlying causes of Addison’s disease can be treated. For example, tuberculosis (TB) is treated with a course of antibiotics over a period of at least 6 months. You can restart when you are well (after hours of eating and drinking normally).
- If you have Addison’s disease, you’ll need to take steroids on a long-term basis, so you should keep a steroid emergency card with you at all times.
- Missing doses of steroids for patients with adrenal insufficiency can lead to adrenal crisis; a medical emergency which if left untreated can be fatal.
- Your GP or endocrinology team can prescribe the medicine needed for an emergency hydrocortisone injection kit.
- Please make sure that the doctors and nursing staff know that your child is on steroid replacement.
A high temperature like this indicates a severe infection or the start of an adrenal crisis. In emergencies, phone 999 and ask for a paramedic ambulance. Do not forget to tell the paramedics that your child is on steroid replacement.
Section 5: Pre-calculated oral hydrocortisone sick day doses
Take a read or watch our latest video on management of Addison’s medication when you have COVID-19 from Professor Simon Pearce. You should give your child their injection given in the middle of the outer side of their thigh. This is because there are no important structures that can be damaged.
Unlike most people, if you feel the urge to eat something salty, then you should eat it. Being aware of kidney function is important in order to maintain health. Many people live with mild and moderately low kidney function, which is often referred to by health professionals as early stage chronic kidney disease or stage 3 CKD.
Treating adrenal crisis
After a serious accident, such as a car crash, a healthy person produces more cortisol. This helps you cope with the stressful situation and additional strain on your body that results from serious injury. As your pharmablockbusters body cannot produce cortisol, you’ll need a hydrocortisone injection to replace it and prevent an adrenal crisis. Gentle exercise such as recreational swimming or walking does not usually need extra medication.
Make sure that you keep taking your medication whatever is going on. An adrenal crisis is serious, uncomfortable and can be life-threatening. A time difference of 1 to 3 hours should not cause any problems. Do not change the time you give your child their hydrocortisone.
Sick Day Rules for medications
If you take a higher dose than necessary for a long time, there’s a risk of problems such as weakened bones (osteoporosis), mood swings and difficulty sleeping (insomnia). Aldosterone is replaced with a medicine called fludrocortisone. Your GP may also ask you to add extra salt to your daily diet, although if you’re taking enough fludrocortisone medicine this may not be necessary.
Managing adrenal insufficiency and steroid replacement
Things like vomiting, diarrhoea, colds and flu could cause an adrenal crisis. It’s important that you spot the early symptoms of a bug or cold and adjust your steroid replacement medication. If their operation is in the afternoon, your child should have their normal morning dose of hydrocortisone.
The card describes the steps that need to be taken in an emergency. It also has a QR code that links to further specialist advice. You can download and carry it with you, or you could use the image of the card as a screensaver on your mobile phone to show healthcare teams in an emergency. A medicine called hydrocortisone is usually used to replace the cortisol.
The specialist team will let you know what to do with your child’s dose of steroids following their operation. Children on hydrocortisone replacement should treble their dose of steroids and also have an oral aciclovir (anti-viral medication). The card will make healthcare professionals aware you’re taking steroids if you’re admitted to hospital in an emergency.
If your child has a minor injury such as a bump, cut or graze and they can recover straight away and resume activities, then you do not need to increase their dose of hydrocortisone. If they are very unwell (see table) then treble their dose of steroids. If they are moderately unwell (see table) then double their dose of steroids.
Ask your GP if there’s one they recommend, or go to the MedicAlert website. You’ll usually need to have appointments with an endocrinologist every 6 to 12 months so they can review your progress and adjust your medicine dose, if necessary. Your GP can provide support and repeat prescriptions in between these visits. Signs of crisis can include severe dizziness with serious vomiting and/or diarrhoea.